Predictors of mortality in older patients with isolated severe head injury: a data linkage study from New South Wales, Australia
Sally Bath A , Michael M. Dinh B C , Stacey Casley D and Pooria Sarrami B E F
+ Author Affiliations
- Author Affiliations
A Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW 2050, Australia. Email: sbat2975@gmail.com
B New South Wales Institute of Trauma and Injury Management, 1 Reserve Road, St Leonards, NSW 2065, Australia.
C Sydney Medical School, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia. Email: michael.dinh@health.nsw.gov.au
D Wagga Wagga Base Hospital, Docker Street, Wagga Wagga, NSW 2650, Australia. Email: Stacey.Casley@health.nsw.gov.au
E South Western Sydney Clinical School, University of New South Wales (UNSW Sydney), Liverpool Hospital, Liverpool, NSW 2170, Australia.
F Corresponding author. Email: pooria.sarrami@health.nsw.gov.au
Australian Health Review 46(1) 107-114 https://doi.org/10.1071/AH21131
Submitted: 14 April 2021 Accepted: 11 August 2021 Published: 29 October 2021
Abstract
Objective This study aimed to identify factors associated with 90-day mortality in older patients with a severe head injury.
Methods A data linkage study was performed with the New South Wales Trauma Registry, Admitted Patient Data Collection and Registry of Births Deaths and Marriages to identify patients aged ≥75 years with isolated severe head injury presenting to trauma hospitals between 2012 and 2016. The primary outcome was all-cause mortality at 90 days.
Results In all, 2045 patients were included in the analysis. The mean (±s.d.) age was 84.5 ± 5.6 years. Falls accounted for 93.7% of this cohort. In-hospital mortality was 28.2% and 90-day mortality was 60.7%. Clinical variables associated with increased 90-day mortality were a Glasgow Coma Scale (GCS) score <9 on arrival (adjusted odds ratio (aOR) 1.43; 95% confidence interval (CI) 1.03–1.98; P = 0.03) and systolic blood pressure ≥180 mmHg on arrival (aOR 1.39; 95%CI 1.05–1.83; P = 0.02). The most important predictor of 90-day mortality was the presence of severe intracranial injury based on computed tomography (CT) imaging. Increasing age and comorbidities were not associated with increased mortality in this cohort.
Conclusions A GCS score <9, severe intracranial injury on CT imaging and severe hypertension on arrival to the emergency department were the variables most strongly predictive of mortality at 90 days after isolated severe head injury in older patients.
What is known about the topic? Older adults with severe injury generally have higher mortality, worse functional outcomes and a greater need for prolonged rehabilitation than younger people.
What does this paper add? Reduced GCS score, severe hypertension on arrival and severe intracranial injury on CT were predictive of mortality after isolated severe head injury in patients aged ≥75 years. There was no association between increasing age or comorbidities and mortality in this cohort.
What are the implications for practitioners? CT scan results and initial observations should play a role in discussions around prognosis and appropriateness of care in older patients with isolated severe head injury.
Keywords: aging, epidemiology.
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